MEDICARE: PROF. BENJAMIN SALAZAR LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	061333	CA
2	106H00000X	Marriage & Family Therapist	81042	CA
3	106H00000X	Marriage & Family Therapist	52049	CA

General Provider Information

NPI Number	:	1548567589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. BENJAMIN SALAZAR LMFT

Provider Business Mailing Address
First Line	:	PO BOX 4024
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91041-4024
Country	:	US
Telephone Number	:	323-793-4944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 N VERDUGO RD STE 203
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-2875
Country	:	US
Telephone Number	:	323-793-4944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	03/30/2026

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